Monday, March 17, 2008

Efforts to keep middle schoolers from consuming alcohol are more effective in rural areas than inner city ones, according to a study carried out by researchers at the University of Florida.

A three-year, three-pronged prevention program did little to keep Chicago middle schoolers from drinking or using drugs, despite its prior success in rural Minnesota, where the program reduced alcohol use 20 to 30 percent, UF and University of Minnesota researchers recently reported in the online edition of the journal Addiction.

"The intervention found to be effective in rural areas was not effective here, which really surprised us," said Kelli A. Komro, Ph.D., a UF associate professor of epidemiology in the UF College of Medicine and the study's lead author. "This is an important finding to realize this program was not enough. The bottom line is this: Low-income children in urban areas need more, long-term intensive efforts."

Adolescents who drink by age 15 - about half of teens - are more likely to struggle in school, abuse alcohol later in life, smoke cigarettes and use other drugs than those who don't. Even worse, exposure to alcohol at a young age may damage the developing brain, according to a 2007 U.S. Surgeon General report.

By targeting middle-school-age children, the UF and University of Minnesota team hoped to reduce these risks. The researchers studied 5,812 sixth-, seventh- and eighth-graders from mostly low-income communities in Chicago, randomly dividing the neighborhoods into two groups: those who would participate in the prevention program and those who would not.

The program, a tweaked version of what Komro and her colleagues developed for their Minnesota study, included three preventive approaches to relay the message that drinking is not acceptable in school, at home and in the community.

In participating schools, an alcohol prevention curriculum was used in the classroom. Students led these sessions because the prevention messages are more accepted when they come from peers rather than teachers, Komro said. The family component included homework assignments that parents and children could complete together, organized events for families, and educational postcards with helpful hints that were sent to parents. For the community aspect of the program, researchers hired organizers to work with community volunteers to change the risks and problems with teen drinking in their neighborhoods.

But at the end of the study, year-end surveys showed no difference in alcohol use among the teens who took part in the project and those who did not. At least 70 percent of the schools in the neighborhoods that did not use the program had some form of drug and alcohol prevention program in the schools. It's unlikely these programs skewed the results of the study though, Komro said. UF's prevention program was larger and more comprehensive than the other school-based programs and researchers would have detected a difference among the students had it worked.

One particular problem surfaced during the community component of the project. The organizers struggled to rally some community members around the cause, often having to explain why they should be concerned about adolescent alcohol use. That gave researchers some insight into why the program did not work there.

"People in these areas are concerned with housing, they're concerned with gangs and other drug use," Komro said. "There was a whole upfront effort where we had to educate people about how alcohol was related to those other issues, and that it was an important issue to think about with their young people.

"We know from other studies in low-income, urban neighborhoods, there is a higher concentration of alcohol outlets, compared to suburban or rural areas. There were a lot of alcohol ads around these schools and a greater density of pro-alcohol messages these children are exposed to. You mix that with the poverty level and it's just a high-risk environment."

Despite the overall results, there were positive findings that researchers hope to build on, Komro said. Of all the components, the family interventions had the most significant effects. And one aspect of the community project worked well: Half of the community teams went to stores that sold alcohol and asked merchants not to sell to underage kids. In those communities, the ability of young people to buy alcohol went down 64 percent.

"While the findings may not be what the investigators were hoping for, they reported them fully and openly, and this is good for the field," said Brian Flay, Ph.D., a professor of public health and director of the Prevention Research Center at Oregon State University. "Science can advance properly only when both positive and negative findings are reported."

The University of Florida Health Science Center - the most comprehensive academic health center in the Southeast - is dedicated to high-quality programs of education, research, patient care and public service. The Health Science Center encompasses the colleges of Dentistry, Public Health and Health Professions, Medicine, Nursing, Pharmacy and Veterinary Medicine, as well as the Veterinary Medical Teaching Hospital and an academic campus in Jacksonville offering graduate education programs in dentistry, medicine, nursing and pharmacy. Patient care activities, under the banner UF&Shands, are provided through teaching hospitals and a network of clinics in Gainesville and Jacksonville. The Health Science Center also has a statewide presence through satellite medical, dental and nursing clinics staffed by UF health professionals; and affiliations with community-based health-care facilities stretching from Hialeah and Miami to the Florida Panhandle.